Top 10 Market Conduct Actions Facing P/C Insurers

October 30, 2018

Untimely claims handling and failure to provide required compliant claims, underwriting, and policyholder service disclosures are the U.S. insurance industry’s top compliance shortcomings. That’s according to a review by Wolters Kluwer of U.S. insurers’ market conduct actions published by state insurance regulators during 2017 along with data compiled by the company.

The review identifies the business areas that were not only examined by regulators, but also proved to be most challenging for the industry in terms of compliance, according to the government and compliance experts at Wolters Kluwer.

“Effectively and sustainably embedding regulatory requirements into claims, underwriting and distribution processes continues to pose challenges for insurers,” said Kathy Donovan, senior insurance compliance counsel for Wolters Kluwer’s. “As routine as many of these compliance challenges may appear, these findings underscore the need for a sound compliance program management system, where regulatory requirements and changes—along with compliance risks and controls—are consistently integrated into an insurer’s exam management program in ways that empower it to strengthen its enterprise controls and audit practices.”

The top market conduct actions taken against U.S. property/casualty insurers during 2017:

  1. Failure to acknowledge, pay, investigate or deny claims within specified timeframes
  2. Failure to cancel, non-renew, renew policies in accordance with requirements
  3. Failure to issue correct payments and/or compliant denial notices
  4. Failure to provide required compliant disclosures in claims processing
  5. Using unapproved/unfiled rates and rules, or misapplying rating factors
  6. Failure to process total loss claims properly
  7. Failure to adhere to producer appointment, termination, records and/or licensing requirements
  8. Improper/incomplete documentation of underwriting files
  9. Failure to provide required compliant disclosures in underwriting processes
  10. Improper/incomplete documentation of claim files

Source: Wolters Kluwer

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